Within two to three days after giving birth, between 70 and
80 percent of women have feelings of heightened sensitivity, sadness, fear,
anxiousness, or of being overwhelmed. Usually the "baby blues" go
away within a week, but if they don't it, may be a sign of a more serious
condition.

In some cases, normal post-birthing feelings such as
irritability and fatigue may be accompanied by paranoia, sleeplessness, and
even mania.

Researchers believe that changes in a woman's hormone levels
both during pregnancy and shortly after the birth of a child are at the root of
what is known as postpartum depression (PPD). Most often, PPD occurs within one
to three weeks following delivery.

It is estimated to affect as many as 13 percent of new
mothers. In the U.S., that's half a million women.

Symptoms of Postpartum Depression

The biological transformations following childbirth affect
all women. For some, however, the changes in hormone levels may lead to
depression.

The symptoms of postpartum depression may include:

anger

irritability

anxiety attacks

trouble eating or sleeping

crying for no apparent reason

feelings of worthlessness

questioning one's ability to parent

suicidal ideation or thoughts of harming the
baby

feelings of franticness, mania, or paranoia

Women who have the most dangerous symptoms associated with
PPD often require hospitalization to protect their health and the welfare of
their newborn.

In a small number of cases, PPD can develop into the much
more serious condition known as postpartum
psychosis.

Risk Factors

During pregnancy, an expectant mother's levels of estrogen
and progesterone rise dramatically in order to help the uterus expand and to
sustain the placenta. Within 48 hours of delivery, however,
the levels of both hormones plummet dramatically. Because both of the hormones
are also associated with neurotransmitters that affect mood, the
"postpartum hormonal crash" may make some women more susceptible to
depression.

Women who have had any type of depression in the past are
more vulnerable to PPD than others. Twenty-five percent of women who have
experienced a prior depression will develop postpartum depression—as opposed to
ten percent who have not. Fifty percent of women who have experienced prior PPD
will incur a relapse after another delivery.

In addition to the trauma of pregnancy and childbirth, the
experiences associated with parenting can lead to postpartum depression. Sleep
deprivation, which is extremely common in new mothers, can exacerbate PPD to
the point where it may be hard to tell if a woman is "sleepy or weepy"
(as one recent paper on the subject put it).

The stresses of new parenthood may also lead to social
isolation and relationship conflicts that can increase the likelihood that a
person will develop PPD. Thus, it is important that new mothers reach out to friends
and family for support during this difficult, yet rewarding time in their
lives.

Diagnosis

If a new mother suspects she has PPD, she or a family member
should contact her doctor or midwife immediately.

Postpartum depression is highly treatable. However, left
untreated, the condition can last for months or even years in some cases.

Postpartum depression is considered a major form of
depression; it is, therefore, important for clinicians to rule out other
medical problems that may cause symptoms similar to PPD. For instance,
anemia—a deficiency of red blood cells—is a common complication with pregnancy
and may lead to fatigue and other symptoms of depression.

Another condition that must be ruled out is a thyroid
deficiency, which may contribute to lowered mood and energy. Both conditions
are easily treatable with either iron pills or hormone supplements.

Treatments

As with other forms of major depression, PPD is best treated
with a combination of antidepressants and talk therapy. However, unlike other
depressions, prescribed medications must be safe for nursing mothers.

In addition, current research reveals that a hormone
treatment including estradiol—a form of estrogen—may have a "rapid
antidepressant effect" on women with PPD. Studies are ongoing but, so far,
they look encouraging.

A Note for New Dads

A 2010 study published in the Journal of the American
Medical Association found that 10.4 percent of new fathers developed
"paternal depression" at some time during their partner's pregnancy
or during the first year of the new baby's life.

The numbers—which are about twice the rates of depression
for men in general—increased if the man’s partner also had PPD.

Symptoms in men with parental depression are similar to
those for women with PPD and may include sadness, anger, irritability, changes
in sleeping or eating problems, and a loss of interest in once-pleasurable
activities.

Men with these symptoms should contact their health care
providers immediately.